Tonsillectomy vs. Deep Tonsil Biopsies in Detecting Occult Tonsil Tumors

Objectives: To compare the yield of detecting occult tumors by performing tonsillectomy and deep tonsil biopsies in patients with metastatic carcinoma to the neck in whom a primary tumor was not evident on physical examination, radiography, or panendoscopy. Study Design: Retrospective study. Methods: Over a 10-year period, the charts of all patients diagnosed with metastatic carcinoma to the neck in whom a primary tumor was not evident on examination, imaging, and panendoscopy were reviewed. Specifically, we compared groups of patients who had undergone diagnostic tonsillectomy with those who had undergone deep tonsil biopsies in search of an occult primary tumor. Results: One hundred twenty-two patients were identified as meeting study criteria. All underwent directed biopsies of the tongue base, hypopharynx, and nasopharynx as well as either deep tonsil biopsies or diagnostic tonsillectomy. Deep tonsil biopsies were performed in 95 patients. In this group, 11 primary tumors were subsequently identified (11.6%): three in the tonsil, six in the tongue base, one in the hypopharynx, and one in the nasopharynx. Tonsillectomy was performed in 27 patients. Eleven primary tumors were identified (40.7%): eight in the tonsils, two in the tongue base, and one in the hypopharynx. All tonsil primary tumors identified were ipsilateral to the presenting neck mass. The overall yield of finding an occult primary carcinoma in the tonsil was 3.2% for deep tonsil biopsies vs. 29.6% for tonsillectomies (P < .0002). Conclusions: Tonsillectomy offers a significantly higher likelihood of finding occult tonsillar tumors than deep tonsil biopsy.